Provider Demographics
NPI:1104961341
Name:ERSKINE, SUZANNE B (DDS)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:B
Last Name:ERSKINE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 E ROOSEVELT ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5589
Mailing Address - Country:US
Mailing Address - Phone:630-665-9850
Mailing Address - Fax:630-665-9266
Practice Address - Street 1:416 E ROOSEVELT ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5589
Practice Address - Country:US
Practice Address - Phone:630-665-9850
Practice Address - Fax:630-665-9266
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19014142122300000X
IL1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223E0200XDental ProvidersDentistEndodontics